Management of Delayed Arterial Hemorrhage After Pancreato-Duodenectomy. A Case Report Study

Context Delayed arterial hemorrhage after pancreatoduodenectomy is defined as bleeding 5 or more days postoperatively. Objective We present the management of delayed hemorrhage after PD, due to gastro-duodenal arterial stump aneurysm. Case report A sixty-nineyear-old man suffering from pancreatic head carcinoma underwent pancreatoduodenectomy. On the 12th postoperative day he developed melena. Endoscopic evaluation revealed occult bleeding coming from the afferent limb of the gastro-jejunal anastomosis. The patient was treated conservatively. On the 15th postoperative day the patient presented a new episode of melena and hematemesis. Upper abdominal series control by computer tomography, selective angiography of the celiac trunk and superior mesenteric artery set the diagnosis of a pseudoaneurysm of the gastro-duodenal arterial stump. The patient was managed by trans-catheter arterial embolization and complete hemostasis was achieved. Conclusion Delayed intraluminal hemorrhage after pancreatoduodenectomy may be caused after pseudoaneurysm due to some visceral arterial stem erosion. Initial management, both diagnostic and therapeutic, should be the angiographic control and trans-catheter embolization of the bleeding vessel. In case of hemodynamic instability or when angiographic embolism is unsuccessful reoperation is the proper treatment. Received February 22th, 2014 Accepted May 1st, 2015